Leadless cardiac stimulation device employing distributed logic

Abstract

Systems and methods involve an intrathoracic cardiac stimulation device operable to provide autonomous cardiac sensing and energy delivery. The cardiac stimulation device includes a housing configured for intrathoracic placement relative to a patient's heart. A fixation arrangement of the housing is configured to affix the housing at an implant location within cardiac tissue or cardiac vasculature. An electrode arrangement supported by the housing is configured to sense cardiac activity and deliver stimulation energy to the cardiac tissue or cardiac vasculature. Energy delivery circuitry in the housing is coupled to the electrode arrangement. Detection circuitry is provided in the housing and coupled to the electrode arrangement. Communications circuitry may optionally be supported by the housing. A controller in the housing coordinates delivery of energy to the cardiac tissue or cardiac vasculature in accordance with an energy delivery protocol appropriate for the implant location.

What is claimed is: 
     
       1. A leadless cardiac pacemaker (LCP) comprising:
 a housing configured for endocardial placement in a chamber of a patient's heart; 
 a fixation arrangement for fixing the housing to cardiac tissue; 
 two or more electrodes supported by the housing; 
 energy delivery circuitry situated in the housing and operatively coupled to two or more of the electrodes for delivering pacing therapy to the patient's heart; 
 detection circuitry situated in the housing and operatively coupled to two or more of the electrodes for detecting cardiac electrical activity of the patient's heart; 
 communication circuitry in the housing configured to communicate with a remote device via sub-threshold conducted communication pulses; and 
 controller circuitry situated in the housing and operatively coupled to the energy delivery circuitry, the detection circuitry and the communication circuitry, the controller circuitry configured to receive sensed patient activity data transmitted using sub-threshold conducted communication pulses by the remote device located outside of the patient's heart via the communication circuitry, and is further configured to autonomously deliver pacing therapy to the patient's heart via the energy delivery circuitry based at least in part on the detected cardiac electrical activity from the detection circuitry and the sensed patient activity data received from the remote device located outside of the patient's heart. 
 
     
     
       2. The LCP of  claim 1 , wherein the communication circuitry is operatively coupled to two or more of the electrodes. 
     
     
       3. The LCP of  claim 2 , wherein the communication circuitry is configured to communicate with the remote device via sub-threshold conducted communication pulses via the two or more electrodes that are operatively coupled to the communication circuitry. 
     
     
       4. The LCP of  claim 1 , wherein the remote device is an implantable device. 
     
     
       5. The LCP of  claim 1 , wherein the remote device is a subcutaneous implantable device. 
     
     
       6. The LCP of  claim 1 , wherein the controller circuitry is configured to communicate with another remote device using sub-threshold conducted communication pulses via the communication circuitry. 
     
     
       7. The LCP of  claim 6 , wherein the another remote device is located outside of the patient's heart. 
     
     
       8. The LCP of  claim 7 , wherein the another remote device is a patient-external system. 
     
     
       9. The LCP of  claim 1 , wherein the communication circuitry is further configured to communicate with the remote device using a non-electromagnetic communication link. 
     
     
       10. The LCP of  claim 1 , wherein the sensed patient activity data received from the remote device via the communication circuitry comprises accelerometer based data. 
     
     
       11. The LCP of  claim 1 , wherein the sensed patient activity data received from the remote device via the communication circuitry comprises blood oxygen based data. 
     
     
       12. The LCP of  claim 1 , wherein the sensed patient activity data received from the remote device via the communication circuitry comprises acoustic based data. 
     
     
       13. The LCP of  claim 1 , wherein the sensed patient activity data received from the remote device via the communication circuitry comprises pressure based data. 
     
     
       14. The LCP of  claim 1 , wherein the sensed patient activity data received from the remote device via the communication circuitry comprises transthoracic impedance based data. 
     
     
       15. A leadless cardiac pacemaker (LCP) comprising:
 a housing configured for endocardial placement in a chamber of a patient's heart; 
 a fixation arrangement for fixing the housing to cardiac tissue; 
 two or more electrodes supported by the housing; 
 energy delivery circuitry situated in the housing and operatively coupled to two or more of the electrodes for delivering pacing therapy to the patient's heart; 
 detection circuitry situated in the housing and operatively coupled to two or more of the electrodes for detecting cardiac electrical activity of the patient's heart; 
 communication circuitry in the housing configured to communicate with a remote implantable device via sub-threshold conducted communication pulses; and 
 controller circuitry situated in the housing and operatively coupled to the energy delivery circuitry, the detection circuitry and the communication circuitry, the controller circuitry configured to receive information transmitted using sub-threshold conducted communication pulses by the remote implantable device via the communication circuitry, wherein the received information is based at least in part on an output of a physiologic and/or a non-physiologic sensor of the remote implantable device, and wherein the controller circuitry is further configured to deliver pacing therapy to the patient's heart via the energy delivery circuitry based at least in part on the detected cardiac electrical activity from the detection circuitry and the information received from the remote implantable device. 
 
     
     
       16. The LCP of  claim 15 , wherein the communication circuitry is operatively coupled to two or more of the electrodes. 
     
     
       17. The LCP of  claim 16 , wherein the communication circuitry is configured to communicate with the remote implantable device via sub-threshold conducted communication pulses via the two or more electrodes that are operatively coupled to the communication circuitry. 
     
     
       18. The LCP of  claim 15 , wherein the remote implantable device is located outside of the patient's heart. 
     
     
       19. A leadless cardiac pacemaker (LCP) comprising:
 a housing configured for endocardial placement in a chamber of a patient's heart; 
 a fixation arrangement for fixing the housing to cardiac tissue; 
 two or more electrodes supported by the housing; 
 energy delivery circuitry situated in the housing and operatively coupled to two or more of the electrodes for delivering pacing therapy to the patient's heart; 
 detection circuitry situated in the housing and operatively coupled to two or more of the electrodes for detecting cardiac electrical activity of the patient's heart; 
 communication circuitry in the housing configured to communicate with a remote device via sub-threshold conducted communication pulses; and 
 controller circuitry situated in the housing and operatively coupled to the energy delivery circuitry, the detection circuitry and the communication circuitry, the controller circuitry configured to receive information transmitted using sub-threshold conducted communication pulses by the remote device via the communication circuitry, wherein the received information is based at least in part on physiologic and/or a non-physiologic data gathered by the remote device, and wherein the controller circuitry is further configured to autonomously deliver pacing therapy to the patient's heart via the energy delivery circuitry based at least in part on the detected cardiac electrical activity from the detection circuitry and the information received from the remote device.